New Research Studies Shed Light on Fighting Chronic Pain

Millions of women spend time and money seeking relief from chronic or constant pain. Recent studies have revealed some fresh approaches to treating severe back pain and other pain conditions. Read on for Lifescript’s roundup of the latest advances in pain research...

Ask a woman whose knee joints ache from osteoarthritis or whose shoulder blades burn all day how her life is affected, and she’ll likely say, “I’m in constant pain.”

Chronic pain affects about 116 million Americans, according to the Institute of Medicine, the health arm of the National Academy of Sciences.

“Back pain is women’s most common complaint,” followed by pain from cancer, abdominal aches and headaches, says Magdalena Anitescu, M.D., Ph.D., an assistant professor of anesthesia and critical care at the University of Chicago Medical Center.

And women feel higher levels of pain than men when faced with similar health conditions, ranging from arthritis to sinus infection, according to new research from Stanford University School of Medicine, published in The Journal of Pain in January 2012.

Why do women suffer more? Read on for the answer and the latest chronic pain research news:

1. Women Feel More PainThe research: Certain painful conditions, such as migraines and irritable bowel syndrome, are more common in women than men, past studies have found. But even when men and women share a condition, such as severe back pain, women report higher pain levels.

On a scale of 1 to 10 (10 being “the worst pain imaginable”), women noted an average score of 6.03 for back pain, compared with 5.53 for men, Stanford researchers found in an analysis of 11,000 patients’ medical records.

Joint and inflammatory pain scored an average of 6 for women versus 4.93 for men. Women’s pain levels were about 20% higher than men’s in most of the 22 categories analyzed.

Researchers don’t know why women report higher levels of suffering; one possibility is that men are taught to hide or underplay pain, so they underreport it, says Atul Butte, M.D., Ph.D., professor of physiology and the study’s senior author.

But it’s likely that women feel pain more intensely because of biological differences, he says. For example, sex hormones such as estrogen may play a role in women’s pain response, possibly by affecting nerves, according to a 2007 report by the International Association for the Study of Pain.

The gender pain gap narrows when measuring headaches and abdominal pain after menopause, when estrogen is less of a factor, the study found.

Also, men and women may react differently to pain medications and anesthesia, with each reporting different levels of effectiveness and side effects. Because of that, researchers believe men and women experience pain differently.

The bottom line: More studies are needed to determine why and how women experience greater pain than men, Dr. Butte says. Those may lead to pain treatment and medication dosages that are better tailored to them.

2. The Brain May Extend Your PainThe research: How is it that two people may heal or hurt differently following the same injury?

The reason may lie in two parts of the brain, according to a small study at Northwestern University’s Feinberg School of Medicine published in the July 2012 issue of Nature Neuroscience.

The brain areas related to emotional and motivational behavior – the nucleus accumbens, at the base of the forebrain, and the medial prefrontal cortex – appear to interact with each other more in patients who develop chronic pain, researchers found.

When this happens, the nucleus accumbens “teaches” the rest of the brain to develop chronic pain, says the study’s senior author, A. Vania Apkarian, Ph.D., a professor of physiology who runs the university’s Pain & Emotions Lab.

It’s not the injury itself, but the brain’s emotional reaction to it, that leads to a chronic condition, he says.

The two areas of the brain involved in this reaction may be naturally more “excited” to begin with in patients whose injuries result in chronic pain. Environmental influences may also trigger the excitable brain response, Apkarian says.

“For the first time, we can explain why people who have the exact same initial pain either go on to recover or develop chronic pain,” he adds.

The researchers tracked 40 patients who had experienced new back injuries that lasted from 4-16 weeks. They underwent brain imaging when the study began and three times more over one year.

After examining the scans for signs of communication between the two brain areas, scientists predicted with 85% accuracy which patients would develop chronic pain.

The bottom line: The more emotionally stimulated the brain is at the time of injury, the greater the chance the patient will develop constant pain.

“Now that we’ve identified a specific brain network critical for chronic pain, the next step is to find out how to alter that brain reaction and create new therapies for treatment,” Apkarian says.

3. Marijuana May Help Relieve Chronic PainThe research: If you’re in constant pain, cannabinoids – medical marijuana’s main ingredient – may enhance the effects of painkillers. They also may allow pain patients to use fewer opiates, reducing the risk of side effects and addiction, according to a small 2011 study by the University of California, San Francisco, published in Clinical Pharmacology & Therapeutics.

The researchers studied 10 chronic pain patients taking their regular outpatient doses of sustained-release morphine and 11 patients taking oxycodone (brand name Percocet). They also received controlled doses of inhaled cannabinoids over four days. The doses of opiates didn’t change.

On day 5 of the study, the team checked opiate levels in the patients’ bloodstreams. Oxycodone levels were unchanged. But morphine levels were lower, so researchers expected those patients to complain of higher levels of pain.

Instead, those on morphine reported a 33% reduction in pain on day 5; the oxycodone group had 20% less pain.

“This preliminary study seems to imply that people may be able to get away with lower doses of the opiates for longer periods if taken in conjunction with cannabis,” says lead author Donald Abrams, M.D., a professor of clinical medicine at UCSF and chief of the hematology-oncology division at San Francisco General Hospital and Trauma Center.

The bottom line: Marijuana could become a treatment for AIDS and cancer patients and others in constant pain, adding to the efficacy of narcotics but with fewer side effects.

Negative side effects may include lower blood pressure and increased heart rate, Dr. Abrams says. It may also cause paranoia. A positive side effect is a decrease in opiate-related nausea.

Most chronic pain patients should be under a doctor’s supervision, Dr. Abrams says. If they use cannabis, they should tell their physician.

Access to marijuana for medical purposes is allowed in only 18 states and Washington, D.C. It’s still illegal under federal law.

4. The Vicious Cycle of Sleep Problems and Chronic PainThe research: People with chronic pain who don’t dwell on their suffering may enjoy improved sleep, according to a study by Johns Hopkins University School of Medicine in Baltimore, published in the April 2012 issue of the journal Pain.

Improved sleep, in turn, may reduce severe back pain and other painful conditions, because earlier studies have found that patients whose sleep is altered are more sensitive to pain, researchers say. That means pain patients could rely less on both sleeping pills and pain medication, says lead author Luis F. Buenaver, Ph.D., assistant professor of psychiatry and behavioral sciences.

Participants answered questions about their level of pain, how they respond emotionally to it, sleep quality and depression. The study found a direct correlation between negative thinking, poor sleep and higher pain levels.

The bottom line: The best way to manage constant pain may be through cognitive behavioral therapy, which helps patients examine and change thinking patterns, he says.

5. Massage Can Help Lower-Back PainThe research: Massage therapy may provide more relief from low-back pain than treatments such as exercise or pain medication, according to a 2011 study by the National Center for Complementary and Alternative Medicine (NCCAM), which was published in the Annals of Internal Medicine.

Researchers looked at 401 men and women ages 20 to 65 who suffered from chronic back pain. About two-thirds of the participants received a series of relaxation (gentle) massages or structural massages (which concentrate on soft tissue and pain spots). The weekly hour-long treatments lasted for 10 weeks.

The other participants received their usual care, which mostly included prescription and over-the-counter medications.

At 10 weeks, more than 1 in 3 of those who received massages said their back pain was much better or had disappeared, compared with 1 in 25 patients who received their usual care. The massage groups spent fewer days in bed, used fewer medications and enjoyed more physical activity.

The massage patients also reported improved back function and were more active for up to a year afterward than those who received painkillers, anti-inflammatory drugs, muscle relaxants or physical therapy, according to the study.

The bottom line: “If you’re having continuing problems with back pain, even after trying usual medical care, massage may be a good thing,” says lead study author Daniel Cherkin, Ph.D., director of Group Health Research Institute, a Seattle-based nonprofit group that provides health-care research to the private and public sectors.

6. Yoga and Stretching Help Back PainThe research: Weekly yoga classes and regular stretching exercises relieve constant pain from lower-back ailments and improve back function, according to a 2011 NCCAM study published in Archives of Internal Medicine.

During the 12-week study, 92 adults with low-back pain took weekly yoga classes; 91 others took weekly stretching classes. Forty-five others were given a book with advice on preventing and managing pain.

Those who took yoga or stretching classes reported significantly less severe back pain and were able to participate in more activities than those who just read books. They also used less pain medication.

The bottom line: Yoga and stretching are safe and effective activities for patients with a history of low-back pain, according to Timothy Carey, M.D., M.P.H., professor of social medicine at the University of North Carolina School of Medicine.

Pilates, an exercise system that focuses on precise movements and postural alignment, may also help ease back pain, according to a January 2012 Australian study published in Medicine & Science in Sports & Exercise.

“When people with back pain start exercising, they may have some pain at first, but generally symptoms improve with continuation of the exercise program,” Dr. Carey says.

Patients who’ve had spinal procedures or neurologic problems should consult with their physician before starting an exercise program, he advises.

7. Obesity and Chronic Pain Are LinkedThe research: It’s no secret that obesity harms health. Now a new review of surveys of more than 1 million people confirms a link between obesity and chronic pain.

The greater the patients’ weight, the higher level of pain they experience, according to a study by Stony Brook University in New York, published in the journal Obesity in January 2012.

Researchers analyzed data from surveys conducted by the Gallup Organization between 2008 and 2010. (Gallup provides research-backed data on numerous subjects to academics, politicians and news organizations.) They determined patients’ body mass index based on their height and weight and compared that with reported pain levels, both over the past year and on the previous day.

The overweight group (with BMI of 25 to 30) experienced 20% greater pain than those with low or normal weight (BMI below 25).

People in the lowest category of obesity (BMI of 30 to 34) reported 68% greater pain; the next-greatest obese group (BMI of 35 to 39) experienced 136% more pain.

The most-obese group (BMI of 40 and higher) claimed 254% greater pain than the low-to-normal weight group.

The bottom line: Ending the obesity-pain link may be difficult, the researchers say. Patients with painful arthritis, for example, may not engage in the exercise that promotes weight loss and may delay seeking medical help.

One solution is non-weight-bearing workouts, such as water exercise in a pool, says rheumatologist Lianne Gensler, M.D., assistant clinical professor of medicine at the University of California, San Francisco.

“It’s good aerobically and the resistance builds strength,” she says. “Any exercise is better than none.”

How Bad Is Your Back Pain?So your back hurts? Take our back pain quiz to see how severe it really is. You may need to see a doctor but have just been avoiding it, thinking it will get better. On the other hand, your back pain may be more normal than you suspect. Find out where your back pain ranks in this back pain quiz.

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